Loading...
HomeMy WebLinkAboutTIFFIN SCENIC STUDIOS, INC.- 341- 8/11/2011 Tiffin Scenic Studios, Inc. Check: 341 146 Riverside Drive Date: 8/11/2011 Tiffin, OH 44883 Vendor: TIFFINSC Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 1 254,720.22 254,720.22 0.00 0.00 254,720.22 Stage Rigging 254,720.22 254,720.22 0.00 0.00 254,720.22 341 8/11/2011 254,720.22 THE SUM OF TWO HUNDRED FIFTY FOUR THOUSAND SEVEN HUNDRED TWENTY DOLLARS AND 22 CENTS Tiffin Scenic Studios, Inc. 146 Riverside Drive Tiffin, OH 44883 Tiffin Scenic Studios, Inc. Check: 341 146 Riverside Drive Date: 8/11/2011 Tiffin, OH 44883 Vendor: TIFFINSC Prior Invoice P.O Num. Invoice Amt Balance Retention Discount Amt. Paid 1 254,720.22 254,720.22 0.00 0.00 254,720.22 Stage Rigging 254,720.22 254,720.22 0.00 0.00 254,720.22 `` C' IA Document G702/CMa — 1992 � t- . Page l of 2 -.i1/4 tiy vs-Q . Application and Certificate for Payment Construction Manager-Adviser Edition @,- '5 10; TO OWNER: PROJECT: CARMEL THEATER APPLICATION NO: 1 Distribution to: Carmel Theater Development Corp. 11711 North Pennsylvania St. PERIOD TO: 5/31/2011 Suite 200 \ OWNER ❑ Carmel, IN 46032 CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: 10!14!2010 ARCHITECT ❑ TIFFIN SCENIC STUDIOS, INC. Signature Construction, LLC PROJECT NOS: I ! CONTRACTOR ❑ 146 RIVERSIDE DRIVE TIFFIN, OH 44883 VIA ARCHITECT: 12012 FIELD ❑ CONTRACT FOR: STAGE RIGGING ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certi ties that to the hest of the Contractor's knowledge. infitrnation and Application is made for payment.as shown below.in connection with the Gmuact, belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet.AIA Document meat,as G70i,is attached. Contract Documents. that all amounts have been paid by the Contractor fix Work for which previous Ccni licates for Payment were issued and payments received from the Owner. and that current 1.ORIGINAL CONTRACT SUM S 522,725.72 payment shown herein is now due. 2. Net change by Change Orders $ 0.00 CONTRACTOR: TIFFIN SCENIC STUDIOS, INC. 3.CONTRACT SUM TO DATE(Line I ±22) s 522,725.72 By: ".Ca t. .r _ . fo-e--- , c1AL 8,t�� Date: 5/16/2011 4.TOTAL COMPLETED 8 STORED TO DATE(Column G on G703) S 283,022.47 State of: OH �q- 5.RETAINAGE: Seneca ``CC a. 10.00 % County of: _ of Work -ay It- MICHAEL J. GRIFFIN (Column D+L=on G7031 s 28,302.25 Subscribed mid sworn «t before _.,,,,� Notary Pudic,State el Ohio me this Public: clay of i on 7:"iP"—,.4: My CommissionExtra 2/J^4t \ b. 10.00 �;of Stored Material 17k arwr. Notary Puhltc. C �� Y'J:1,1± 'r 0 (Column F on G7031 S 0.00 My Commission emu es: 'Jr /,,4 �? :aGi=:,„s• Total Retainage(Lines 5a+5h or Total in Column I of G703) S 26,302.25 CERTIFICATE FOR PAYMENT a e of ° 254,720.22 In accordance with the Contract Documents. based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE s this application, the Constriction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated. the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT S 0.00 accordance with the Contract Documents.and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 254 8.CURRENT PAYMENT DUE S ,/20.22 [� AMOUNT CERTIFIED s ZS-/ 220 . -2 ."1 - 9.BALANCE TO FINISH,INCLUDING RETAINAGE (a nurll e.rplamarinn if antigun certified diyrera from the umuuat<q,plU'd. mum/Id!'wan u'ex nn this r%pplhntiun and on the C end,urarinn Sheet that ore changed to em Jnrm with the amount ce'rii/ied.) (Line 3 less Line 61 S 268,005.50 CONSTRUCTION MANAGER: By: Date: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ept;HITFar: 01....4h-c°l- "'.+ Total changes approved in previous months by Owner S 0.00 S 0.00 By: ��� � , Date: 6�// / I V Total approved this Month 5 0.00 S 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS S 0.00 S 0.00 named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of • NET CHANGES by Change Order 5 0 00 the Owner or Contractor under this Qmt ract. CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G702/CMa^e-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law and International Treaties. - Unauthorized reproduction or distribution of this AlAs Document,or any portion of it,may result in severe civil and criminal penalties.and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To moon copvrioht violations of AIA Contract Documents.e-mail The American Institute of Arrhi:erts'Iena1 rn,mcul rnnodnln(bia nrn 1- ' Document G703r"t - 1992 To. From Contractor. Carmel Theater Development Corp. TIFFIN SCENIC STUDIOS,INC. 11711 North Pennsylvania St. 145 RIVERSIDE DRIVE Suite 200 TIFFIN,OH 44883 Continuation Sheet Carmel.IN 46032 AIA Document G702.Ta'.Application and Certification for Payment. APPLICATION NO: containing Contractor's signed certi ligation is attached. Project. APPLICATION DATES Page 2 of 2 in tabulations below. amounts are slated to the nearest dollar. CARMEL THEATER 116/2011 Use Column I on Contracts where variable retaina_3c liar Iime items Ina).apple. PERIOD TO.5/31/2011 ARCHITECT'S PROJECT NOt)n12 A _ B C 0 I E I F C H I WORK CON IP LET El) I TOTAL MATERIALS BALANCE SCHEDU LEI7 CO?IPLETED ITEM DESCRIPTION 17F WORK FROM PREVIOUS PRESENTLY % TO RET.AiNAGE VALUE ,APPLICATION THIS PERIOD STORED AND STORED rG-CI FINISH dl rariidrk art.o NO. TO DATE en+t-1 L1'ur in Dor Ls rD=E_la !C-Gl 1 111-1000 Tension Grid-Labor 8,86700 0.00 0,00 0.00 0.00 0 8.867.00 090 111-1001 Tension Grid- Mat. 25,910.00 0.00 000 0.00 0.00 0 25,910.00 0.00 111-1002 Tension Grid-Install 7,633.90 0.00 0.00 0.00 0.00 0 7,633 00 0.00 2 111-1003 Cv4.Rigging-Labor 88,250.00 0.00 66,18750 0.00 55,187.50 75 22,062.50 6.618.75 111-1004 Cwt. Rigging- Mat, 213,911.73 000 160,433.80 0.00 160.433.80 75 53,477.93 16.043,38 111-1005 Cwt. Rigging-Install 70,219.27 0.00 52,664.45 000 52.664.45 75 17,55482 5.266.45 3 111-1006 Tracks&Pipes-Labor 1,500.00 0.00 0.00 0.00 0.00 0 1.500,00 0.00 111-1007 Tracks 8 Pipes-Mat. 3,992.00 0.00 0.00 0.00 0.00 0 3,99200 0.00 111-1005 Tracks&Pipes-Install 1,269.00 0.00 0.00 0.00 0.00 0 1.269.00 000 4 111-1009 Fire Cur.Rigg-Labor 8,500.00 0.00 0.00 0.00 0 00 0 8,500 00 090 111-1090 Fire Cur.Rigg-Mat. 17,560.00 0.00 000 0.00 0.00 0 17,56000 0.00 111-i011 Fire Cur Rig-Install 6,052.00 0.00 000 0.00 000 0 6,052.00 0.00 5 111-1012 Fire Curtain-Mat. 13.770.00 0.00 0.00 0.00 000 0 13,770.00 0.00 111-1013 Fire Curtain-Install 3,221.00 0,00 000 0.00 0.00 0 3.221,00 0.00 5 111-1014 Pic.Screens-Mat, 7.9.28D0 0.00 0.00 0.00 0.00 0 7,928.00 0.00 111-1015 Pic. Screens-Install 1,855.00 0.00 0.00 0.00 0.00 0 1.85500 0.00 7 111-1016Pit InFill-Mat. 13,376.00 0.00 000 0.00 0.00 0 13 376.00 0.00 111-1018 Pit InFill-Install 5,175.00 000 0.00 0.00 0,00 0 5.175.00 0.00 8 111-101$P&P Bond 3,736.72 0.00 3,736.72 0.00 3.735,72 100 0.00 373.67 9 111-101gAllowance 20.000.00 0.00 0.00 0.00 0.00 0 20000.00 900 GRAND TOTAr. 522,725.72 0.00 283,022,47 000 1 253,022.47 54 239,703.25 28,302.25 • CAUTION:You should sign an original AIA Contract Document, on which this text appears in RED.An original assures that changes will not be obscured. AEA Document 6703 TM-1992.Copyright©1963. 1965,1966, 1967. 1970, 1978. 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlAe Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA"Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(101 copies of this document when campleled,To report copyright violations of AIA Contract Documents.e-mail The American institute of Architects'legal counsel,copyright @aia.org, PRIME CONTRACTOR'S SWORN STATEMENT OF INDEBTNESS & WAIVER OF LIEN STATE OF Indiana COUNTY OF Hamilton Brad E. Bossier Being duty sworn upon his/her oath disposes arid says that: 1. He/she is President (inserting sole proprietor, partner or corporate office held, as the case maybe), of Tiffin Scenic Studios, Inchereafter called the "Prime Contractor". He/she is over the age of twenty-one. He/she is authorized to make this affidavit on behalf of Prime Contractor. 2. Prime Contractor is the stage Rigging Prime Contractor for the construction of the development known as VILLAGE ON THE GREEN — PARCEL 7C1 — THEATER BUILDING located in CARMEL (City). INDIANA (state), hereafter referred to as the "Development", pursuant to the contract between the Prime Contractor and CARMEL THEATER DEVELOPMENT CORPORATION, LLC.,the Owner. 3. This affidavit is made for the express purpose of inducing and CARMEL THEATER DEVELOPMENT CORPORATION, LLC., to make payment to Prime Contractor of the invoice submitted herewith for labor and materials furnished pursuant to said Contractor. Upon receipt of said payment the Prime Contractor hereby waives any lien rights to which Prime Contractor is entitled for labor or materials furnished for the development to the dale hereof. 4. Listed below are all suppliers or other persons who either has furnished or might furnish the Prime Contractor with materials, appliances, machinery. fixtures or furnishing placed upon or installed on the development. Mark (X) in the appropriate column for EACH supplier listed. Place an (X) in column: 1) If a waiver of lien by supplier conditioned by payment of a specified amount is attached hereto. (In this case also show the amount owed the supplier). 2.) If a FULL (final) lien release has been signed and delivered to the Owner. 3.) If the initial delivery has not been made. upplier List (Add list if necessary 1. Amount Owed 3 N/A f #1 and 2 correspond to the same numbered choices on the waiver format. CARMEL THEATER DEVELOPMENT CORPORATION, LLC.is hereby authorized to make payment to each such unpaid creditor either directly or by check jointly payable to Prime Contractor and such creditor, as CARMEL THEATER DEVELOPMENT CORPORATION, LLC. shall determine. 5. There are no bills. charges, costs or expenses for labor or material which could now or hereafter result in lien being filed against the Development or a claim being asserted against the Owner except the persons or businesses named in Paragraph 4 above. IN WITNESS WHERE OF, affiant has signed this document on behalt of the Prime Contractor this /7.14. day of 20 .t S y 1 -J^141/ J/ I i 1�.r.1t C.. 4L- (Authorized Representative of Prime Contractor, Title) County of Seneca ) State of Ohio Subscribed and sworn to before me, a Notary Public in and for said County and State, This ./r/ Day of /7"70-43/ , 20 di! 4rppl1AL '.Jr ary Pub') MICHAEL.1. GRIFFIN (',:•'�.a'~�'� Notary Public,stab of cti 7 Michael J. Griffin ' fly\S,10,Lix>y MyfAm,msiCql -Shaba (Printed Name) c*tty; O My Commission Expires: r9TE F O,!`° NOTARY SEAL MUST APPEAR ON THIS FORM. 1